How To Cope With A Mental Health Relapse
By Sarah Graham
They say admitting you need help is the first step to recovery. But what if you’ve already recovered? What if you’ve done everything in your power to get better and, crucially, to stay better but you’ve still woken up, less than a year after you’d declared yourself well enough to come off antidepressants for good, feeling like there’s absolutely no decent reason to get out of bed?
“It’s just a relapse,” my GP told me, in that reassuring, sympathetic tone that I’m always so grateful for. But it didn’t feel like “just” anything. It felt catastrophic, an abject failure, the end of my newly rebuilt life as I knew it.
Of course, it wasn’t any of those things really. But coming to terms with a mental health relapse felt almost harder than the relapse itself.
I have a long and complicated relationship with fluoxetine — or Prozac, as you might know it. One of the most commonly prescribed SSRI antidepressants in the UK, I first went on it in 2013 for mild to moderate symptoms of depression and anxiety. I started off on a relatively low dose of 20mg, which I found was enough to keep me on an even keel.
Then, in 2017, I was involved in a traumatic car accident and my mind span as wildly out of control as my car. Within hours, staring up at the hospital ceiling tiles from my spinal board, I had plunged from mild, well-managed depression to a much darker and scarier place. People repeatedly told me how lucky I was to have survived but, after the first six hours of desperately hoping I wasn’t going to die, I’d spend the next six months wishing I had.
“‘It’s just a relapse,’ my GP told me, in that reassuring tone that I’m always so grateful for. But it didn’t feel like ‘just’ anything. It felt catastrophic, an abject failure.”
When I was discharged five days later, with a “badly smashed up” left wrist and two fractured vertebrae, the hospital psychiatrist prescribed diazepam (Valium) for the anxious car journey home — but I was still a quivering wreck, gripping my husband’s hand as if my life depended on it, while my father-in-law drove slower and more carefully than he ever had in his life.
Over the following months I was diagnosed with post-traumatic stress disorder (PTSD), my fluoxetine dose upped from 20mg to 40mg, then again to 60mg — the maximum dose. I was prescribed more diazepam and then propranolol, a beta-blocker, for the anxiety and put on a 17-week waiting list for high intensity, trauma-focused cognitive behavioural therapy (CBT).
Recovery — physical and mental — was slow, frustrating and at times pretty bleak. But antidepressants kept me alive and, slowly but surely, things started to shift. My NHS CBT therapist was amazing — just life-changingly brilliant — and after 13 weekly sessions with her I’d progressed from self-harming and self-destructive to believing that recovery was possible, and being proactive about making it happen.
My partner and I accelerated our plans to move out of London, finding peace in a green and quiet suburb, closer to my support network of family and friends, where we could afford a house with a garden and where neighbours chat to each other. I got back into exercise as soon as my broken body would allow. I started eating better and cutting down on alcohol, which had rapidly become an unhealthy coping strategy. I read up on post-traumatic growth and gradually got back into a proper routine, taking on new and exciting work opportunities and challenges, volunteering once a week and incorporating real, meaningful self-care into my everyday life.
By April 2018 I felt like I was ready to be less reliant on antidepressants. Having previously pitched, researched and written a feature on the challenges of tapering off SSRIs, I knew I wanted to take this really slowly, making sure I was absolutely ready at each stage in the process before moving on to the next. My GP recommended coming down by 10mg at a time, with at least two weeks at each lower dosage — so I could have got down to zero within three to six months, but instead I took 14.
“When I finally said goodbye to Prozac, I felt unstoppable. I treated myself to a Maya Angelou tattoo, ‘And still I rise’, symbolising the progress and closure I felt I’d achieved.”
When I finally said goodbye to Prozac, in June 2019, I felt unstoppable. I was smashing it in my freelance career, training for a half marathon and had a solid self-care regime of regular exercise, massages and therapy. I was making friends in my new local area, we’d got a dog who was getting me out of the house on a regular basis, and I was finally taking baby steps to rebuild my driving confidence. I even treated myself to a Maya Angelou tattoo, “And still I rise”, symbolising the progress and closure I felt I’d achieved.
And then, boom. Within six months it all came crumbling down. The emotional equivalent of a sucker punch to the gut caught me totally off-guard and I was floored by an intense wave of grief, shock, anxiety and despair. For a couple of months I hardly left my bed, much less my house. Work ground to a halt as I struggled through the bare minimum I needed to meet my existing deadlines, otherwise feeling too crippled by depression and anxiety to seek out anything new.
I told myself it was temporary. That I’d feel better after our holiday — but I didn’t. That I’d take two full weeks off over Christmas and New Year, and feel better after that — but I didn’t. By the end of January, when the third anniversary of the accident rolled around, I’d been a floppy, useless mess for the best part of three months and I knew something had to give. Reluctantly, I made an appointment with my GP, who suggested going back on fluoxetine at 20mg.
Rationally I knew that these things happen. Recovery is never linear, everyone’s mental health fluctuates, and there’s never any shame in going on (or back on) medication if you need it. I wouldn’t hesitate to call out anyone saying it about themselves or someone else, but at a deep emotional level I felt like I’d failed. I’d done everything right, taken all the advice, followed all the steps, and yet here I was. I felt like I was back at square one, and that all my hard work had been for nothing. I felt like I’d been naïve, stupid and complacent to believe I was ‘fixed’. I was terrified that I’d be stuck in a never-ending cycle of constantly having to start all over again from scratch, only for everything to keep falling apart.
But after a couple of weeks back on the good stuff, the clouds started to lift, the fog cleared and I began to feel like myself again. I realised that I’m really no worse off than I was before the relapse, and that antidepressants are just medicines that we take, for the same reason we’d take any other medicine.
“Recovery is never linear, everyone’s mental health fluctuates, and there’s never any shame in going on (or back on) medication if you need it.”
Stephen Buckley, head of information at mental health charity Mind, tells me: “Our mental health is just like our physical health — it can fluctuate from good to poor, and we need to take care of it. Most people will find that it’s a combination of treatments that help them best manage a mental health problem, which could include medication, talking therapy and self-care techniques such as meditation, mindfulness and physical exercise.”
“It’s important to identify how your mental health problem affects you and notice when you’re becoming unwell, so that you can ask for help from your GP if needed. If you’re prescribed medication, such as antidepressants, you shouldn’t feel ashamed about taking them. Medication doesn’t work for everybody, and generally can’t cure a mental health problem, but it might help lift your mood so you feel more able to access long-term support and treatment,” he adds.
“If you decide to come off mental health medication, this needs to be done gradually, while being carefully monitored by your GP. If in future your mental health worsens and you find you need to start taking medication again, try not to see it as a step backwards, or that you’re somehow failing. While some people will experience a one-off episode of depression, others will find that their symptoms return over time, therefore some people will find they might need to take psychiatric medication in the long term.”
The problem is — for all the improvements to the mental health conversation in recent years — I still felt so deeply ashamed and embarrassed of my glitchy mental health, in a way that I’d never feel about my immune system if I were repeatedly struggling to shake off cold and flu infections.
I’ve still found this hugely challenging to write, and I’m not sure how widely I’ll share it on social media, but it feels important to say. We read so much about people’s struggles with ‘overcoming mental illness’ but much less is said about the fact that this is an ongoing journey, not a one-off battle to be won. Mental health relapses are hard — devastating even — but they’re just a bump in the road, not a ditch.
For more information on withdrawing from mental health medication, visit Mind.
Originally published at https://refinery29.com.
